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\n"; } if (!isset($errorMsg)) { header("Location: paypalcheckout.php3"); include('process.php'); } }?> ROSACEA-LTD discusses treatment & symptoms of acne rosacea, ocular rosacea, etc.

Order Rosacea-Flushing Ltd IV

This site is for Rosacea-Ltd IV International customers (those living outside of the 50 states).

Rosacea-Ltd IV has a 120-day, 100 percent refund for any reason. It costs $88.00 for the two Rosacea-Ltd IV disks. This also includes taxes and air postage throughout the world (some countries and/or provinces may have an import tax collected upon delivery). If you are not completely satisfied with Rosacea-Ltd IV, simply return the unused portion.

Bass & Boney, Inc.
100 Europa Drive
Suite 331
Chapel Hill, North Carolina 27517 USA

For our international customers who need to find the exchange rate,
a helpful web page is:
http://www.xe.net/currency

Please note: This form is designed to be submitted via the Internet. If you make a mistake, simply backspace or delete (depending on your computer). The submit button is at the bottom of the screen. However, you may fill it out on screen, then print it out and mail in to BASS & BONEY, INC. at the address above. If you prefer, you may print it out blank, fill it in by hand, and mail it.

Absolutely NO name or other personal information submitted to this web site will be distributed to any other company or person for any reason. All information obtained from this site will be used exclusively by Bass & Boney, Inc. to assist our customers in treating rosacea, acne or seborrheic dermatitis skin conditions. The electronic record of each transaction is deleted as soon as the order is printed for immediate processing. Click here to review our privacy policy.

The NAME and E-MAIL ADDRESS fields are required to be completed before the order can be electronically submitted.

Age Male Female Full name Street address (including Apt. #) City & Province Country & Postal code Daytime telephone num. Intl customers: please use the format (+####-####-####) E-mail Address

          Age         

                      

    Full name         
Street address        
(including Apt. #)
City                  
State or Province     
ZIP or Postal code     
Country               

Daytime telephone no. 


        E-mail Address

As the symptoms of rosacea vary with each individual, we prepare a different Letter of Instruction for each person based upon your redness, intensity of redness, degree of severity of rosacea papules, acne pimples, spidery blood vessels, age, and present and past medications and treatments, exercise, etc. Also any questions that you may have can be answered within your Letter of Instructions.

Please answer all questions below which will assist us in writing the best Letter of Instructions.

What is your skin type? /> Oily
/> Oily & dry
/> Normal
/> Dry Do you have acne (pimples that come and go)? /> Yes
/> No If yes, number and size would be considered: /> Mild
/> Moderate
/> Severe Do you have rosacea papules (bumps without pus/raised lesions that stay)? /> Yes
/> No If yes, number of papules would be considered: (Advanced stages sometimes weep clear fluid.) /> Mild
/> Moderate
/> Severe Overall facial redness: /> Mild
/ > Moderate
/> Severe Does your skin break out with hives, such as blotches when you apply topical facial medication? /> Yes
/> No Do you have seborrheic dermatitis on your face? /> Yes
/> No Do you have ocular rosacea? /> Yes
/> No What rosacea medications do you currently use? How long have you used them? What other acne, anti-wrinkle, or topical medications do you currently use? How long have you used them? Are you using photoderm, laser, or any other type of light surgery? /> Yes
/> No If yes, how long ago? What rosacea medications have you used in the past? Are you currently using a steroid or cortisone treatment for rosacea that has thinned your skin? /> Yes
/> No How long have you used it? In the past, have you ever used a steroid or cortisone treatment for rosacea? /> Yes
/> No How long did you use it? How long ago did you stop? How many glasses of these liquids do you drink each day, on the average? (One glass is about eight ounces or 1/4 liter.) Water Tea/coffee Fruit juice Carbonated drinks Alcoholic drinks How many glasses of water will you be drinking in the future each day? How many hours do you exercise during an average week? How many hours do you spend outdoors during an average week? What is your body weight? Please inform us in the box below of a repeat Rosacea-Ltd order or anything unusual in the above questions, or to add clarity, or to add any information that you might think would be helpful in writing your your Letter of Instructions. Please only tell us of unusual or exceptional things that are not typical of rosacea. Also feel free to add more information as to other medical conditions as often there is a relationship as most medications are acidic with side effects. And feel free to ask any question which we will answer in your Letter of Instruction. There is enough room for at least six full pages. Thanks for your Rosacea-Ltd IV order.

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